Reducing Leprosy in Nigeria

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As Nigeria joined the rest of the globe recently to commemorate World Leprosy Day, experts have reiterated that stopping stigmatisation, early diagnosis and improved treatment are the panacea for eradicating the disease in the country, Martins Ifijeh writes

When in 1999 the World Health Organisation (WHO) delisted Nigeria from the list of high endemic nations with leprocy, its reason was that the country had achieved the target of at most, one case per 10,000 persons. But recent reports show that the country relapsed after the achievement, thereby giving room for the neglected tropical disease to stage a come back with high prevalence rate in the country.

Experts say in recent years, at least nine persons were being diagnosed with the disease daily, which amounts to over 3,000 Nigerians officially presenting with new cases of leprosy every year. A development they say was increasingly worrisome since the country was already cleared of the high prevalence rate of the disease still being experienced in some developing countries.

For instance, in 2015, a total of 2,892 new cases were diagnosed, among which nine per cent were children and 15 per cent had grade two disabilities because of late presentation at hospitals, according to the federal government last year. It is believed a lot of people do not also present their cases at all, thereby fueling the possibility that hundreds or thousand more cases are un-presented yearly.

The WHO says the resurgence of the disease in some countries and the deformity experienced by a percentage of its victims were due to high and continuous level of stigmatisation, which it said has in no small measure contributed to the apathy among persons living with leprosy to come out and seek help.

It is in tackling these issues that the Minister of Health, Prof. Isaac Adewole, during the commemoration of the 2017 World Leprosy Day in Umuahia, called for an end to stigmatisation of persons affected by the disease, adding that, people suffering from the disease need love, care and a sense of belonging. “Early diagnosis will go a long way in reducing disabilities experienced from it,” he noted.

He said the scourge still posed a challenge to the country due to the pockets of high endemicity in some states such as Jigawa, Kano, Kaduna, Kebbi, Bauchi, Taraba, Niger, Kogi, Ebonyi, Abia, Cross River, Edo, Osun, Ogun and Lagos.

“What is of utmost concern now is the existence of new leprosy cases that are reported each year among the general population, including children and those with grade two disabilities.”

According to him, there was no point stigmatising victims, which he said has often been the case, adding that all they need was love and care to be able to go through treatment and get cured.

“There are different beliefs about the diseases. Some say it is highly contagious, others believed either it is hereditary or it is heaven’s punishment to negative people,” adding that, “this has in no small measure affected victims psychologically and socially.”

He recalled that “In 1998, after the introduction of the Multi- Drug Therapy (MDT), Nigeria achieved WHO’S elimination target of less than one case per 10,000 population at the national level, saying lateness in presenting cases at the healthcare facilities made matters worse.

As part of ways to mitigate the negative notions about the disease and reiterate interventions, the minister said the federal government had launched a five-year National Leprosy and Buruli Ulcer Strategic Plan (2016-2020) as this would help eliminate the disease in the endemic states.

“This document facilitates the implementation of appropriate strategies to increase case detection, improve treatment outcome, prevent disabilities and provide rehabilitation services to affected persons,” he said.

It is expected that at the end of 2020, visible and recorded achievements will include “aiming to reach 0.1 case per million population, zero grade two disabilities among new child leprosy cases and all states to report less than one per cent case.”

He expressed commitment to work with partners so as to ensure effective and sustained leprosy control, and to achieve a reduction in stigma and discrimination in the country, urging the media and civil society organisations to help propagate the message that “leprosy is curable and treatment is free” in addition to public enlightenment against stigmatisation and discrimination.“What they need is love, understanding and your support,” he said.

Leprosy, a neglected tropical disease, is a chronic infectious disease caused by Mycobacterium leprae. It mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes. It is curable and treatment provided in the early stages averts disability.

According to WHO, leprosy is infectious (though it may not be highly infectious). It is transmitted viadroplets, from the nose and mouth, during close and frequent contacts with untreated cases, adding that untreated leprosy can cause progressive and permanent damage to some parts of the body.

WHO has maintained that early diagnosis and treatment with multi-drug therapy remain the key elements in eliminating the disease as a public health concern.

Also on his part, a public health expert, Dr. Paul Kuforiji, said this year’s commemoration should be a wake up call to stakeholders and the government in the provision of new ways of tackling the disease, which on a daily basis was gaining prominence in the country. “Strategies should be in place to halt the present spread. There should also be a scaled up treatment plan, as well as awareness on the part of the citizens that it was not only curable, but treatment could be accessed free of charge.”

On signs to watch out for, he said severe pain, muscle weakness and paralysis (especially in the hands and feet), thick, stiff or dry skin, discolored skin lesions, white patches of the skin with loss of sensation, among others.

According to him, “leprocy is curable, but the best time to tackle it is at the early stage,” adding that those people who are seen with deformities were majorly those who did not present their issues on time, thereby allowing the disease to cause deformities in them.”

Meanwhile, the Junior Chambers International has called on the government to put laws on ground to protect people living with leprocy, as they often become the scorn of the society, even after being cured.
Stating this during a recent Gala Night of the Northern Conference of the group, its 2016 National President, Mr. Olatunji Oyeyemi said a lot of the time, people living with leprosy have been neglected by the government, thus allowing them to rot away.
“If you look at our environment today across the country, people living with leprosy cannot stay within the city. For other illnesses you can stay with your family and they will take care of you, but for people affected with leprosy, even when they are cured, they are seen as outcast, they are sent out of the communities, they live miserable life, and government is not paying attention, community is not paying attention, and we regard these people as one of us that should not be thrown away especially when they are cured.
“Government should make laws to protect the rights of people affected or living with leprosy because they are also human, they have the right to life, good medical care, their children which most times are being neglected to stay with them in camp have the rights to go to school, among others,” he stated.
He called for full integration of leprosy treatment into general health services, adding that political commitment needs to be sustained in countries where leprosy remains a publichealth problem.

“Government should ensure all that are needed to support people living with leprosy are planned and provided for,” he said.

The age-old stigma associated with the disease remains an obstacle to self-reporting and early
treatment. The image of leprosy has to be changed at the global, national and local levels. A new environment, in which patients will not hesitate to come forward for diagnosis and treatment at any health facility, must be created.